Salivary cortisol determination in ACTH stimulation test to diagnose adrenal insufficiency in patients with liver cirrhosis

Lara Albert, Joaquím Profitós, Jordi Sánchez-Delgado, Ismael Capel, José Miguel González-Clemente, David Subías, Albert Cano, Eugenio Berlanga, Anna Espinal, Marta Hurtado, Rocío Pareja, Mercedes Rigla, Blai Dalmau, Mercedes Vergara, Mireia Miquel, Meritxell Casas, Olga Giménez-Palop

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Resumen

Purpose. The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) correlates better with FC. We aimed to establish SaC thresholds for AI for the 250 μg intravenous ACTH test and to estimate the prevalence of AI in noncritically ill cirrhotic patients. Methods. We included 39 patients with decompensated cirrhosis, 39 patients with known AI, and 45 healthy volunteers. After subjects fasted ≥8 hours, serum and saliva samples were collected for determinations of TSC and SaC at baseline 0'(T0) and at 30-minute intervals after intravenous administration of 250 μg ACTH [30'f(T30), 60'f(T60), and 90'(T90)]. Results. Based on the findings in healthy subjects and patients with known AI, we defined AI in cirrhotic patients as SaC-T0 < 0.08 μg/dL (2.2 nmol/L), SaC-T60 < 1.43 μg/dL (39.5 nmol/L), or ΔSaC
Idioma originalInglés
Número de artículo7251010
PublicaciónInternational Journal of Endocrinology
Volumen2019
DOI
EstadoPublicada - 1 ene 2019

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